Reviews & Analysis

Autoantibodies associated with systemic lupus erythematosus are also frequently observed in apparently healthy individuals. In this Opinion article, the authors consider the implications of this benign autoimmunity with regard to the normal immune response and the development of disease.

Mesenchymal stem cells (MSCs) have shown some degree of therapeutic benefit and MSC-based therapies are currently offered at many centres worldwide; nevertheless, firm scientific evidence of the effectiveness and safety of such therapies is severely lacking, and a number of issues regarding the characterization and manipulation of MSCs remain to be adequately clarified. Alan Tyndall discusses these issues and provides his opinion on the optimism shown to such therapies to date.

Comparative effectiveness research (CER) takes the clinical characteristics of patients into account to determine the most beneficial treatments. Here, the methodological approaches and the analytical challenges of CER are described, as well as the considerations needed to ensure high-standards of CER in rheumatology.

Skeletal abnormalities of the hip can place unnecessary stress on structures within the hip. One of these abnormalities, in which the head of the femur develops a cam-shaped outgrowth, has been associated with the subsequent development of osteoarthritis. In this Perspectives, the etiology of cam abnormalities and their contribution to osteoarthritis are discussed.

A number of issues limit the utility of the definitions and classifications of autoinflammatory disease proposed to date. In this Perspectives, the authors propose a new clinically-based definition and classification of autoinflammatory diseases. In addition, a potential future approach to classification of the entire spectrum of immunological diseases is discussed.

Systemic lupus erythematosus (SLE) is a heterogeneous condition characterized by a wide range of symptoms, rendering its diagnosis an often difficult task. In this article, the authors highlight the current approaches and challenges in SLE diagnosis, propose an algorithm to facilitate this process, and argue for the development of endorsed diagnostic criteria.

Fibromyalgia is a controversial condition, and opinions are divided over whether psychocultural factors explain fibromyalgia content or whether it is largely a product of disordered central pain processing. In this article, Wolfe and Walitt describe how the definition of fibromyalgia has changed during its history, and discuss the factors that have enabled it to persist despite the ongoing debate.

Myositis results from the combined activities of immune-specific and muscle-specific cell types. Immune muscle precursors could have a pivotal role, as they stimulate inflammation and the generation of autoantigens. Tournadre and Miossec explain this phenomenon.

The contribution of epigenetic mechanisms, primarily comprising microRNAs and modifications of DNA and histones, to rheumatoid arthritis (RA) is increasingly recognized. In this article, the authors discuss the role of the epigenetic machinery in this disease, with a particular focus on the enzymes that regulate protein acetylation, and the therapeutic potential of targeting these factors in RA. The authors suggest that returning to the original, broader definition of epigenetics, comprising all nongenetic regulatory mechanisms, might improve our understanding of disease and facilitate the development of novel therapeutic strategies.